13 Family SystemsUnderstanding impact of present and past family patterns of behavior on the choices we makeCan lead to intentional desire to make changes and refusal to continue cycle

14 Family Systems Nuclear family of originIncludes family history/relationshipsSingle emotional unit of relationships that intermingle over generationsFamily Dynamics – key to understanding current behaviorsTend to seek partners of similar differentiation

15 Family Systems: HealthyClear generational linesStrong parental coalitionMaintenance of marital relationshipCommunication is clear, honest, direct, specific and congruentRoles clear and not defined by genderRules defined and respectedOkay to express ideas that differDifferences accepted

16 Family Systems: HealthyEmpathy, warmth & caring expressedFeelings addressedLevel of conflict low and resolvedHigh self-esteemParents make decisionsHealthy lifestyleRegular exercise & recreationAbsence of dangerous activitiesNo significant deviance in school or work performance, or in relationships with others

17 Family Systems: TroubledStrive to do wellBoundaries appear clear, but when under pressureTurn inward (rigid) orProblems spill into the environment (disordered, diffuse)Links to society may be mistrustful, with limited input from larger societyChildren learn power through manipulation rather than learning responsibility

18 Family Systems: TroubledPower may be diffuse and may not come from parentsLittle empathy shownConflict over rules & family normsCaring is controlling rather than growth producingSelf-esteem low

19 Family Systems: Troubled (continued)Parental coalition present, but weak and ineffectiveParents may reach across generational boundaries for comfort and support“Triangled” often symptom bearerOvert or covert incestuous situations may be present

20 Family Systems: Troubled (continued)Communication: May not be clear, honest or specificExpressed with fear, guilt or angerIncongruence between verbal and nonverbalDisqualification through silence, ignoring, evasiveness or changing subjectExcessive use of alcohol, nonprescription and Rx drugsEventual dysfunction of one or more family members

21 Family System and ChildrenChildren are affected by family relationshipsMarital conflictFightingSiblingsBoundariesParental psychopathologySeparation/loss: death, divorce, absent parent

22 Family PsychoeducationFocus on education & supportWorks best with family & client with major mental illnessTechniquesCommunication trainingProblem solvingGoals:Improve course of the family member’s illness relapse rates client and family functioningGoals achieved through:Educating family about mental illnessTeaching families techniques to copeReinforcing family strengths

23 Commonalities of Family TheoriesIndividual symptoms understood in context of family systemFacilitate interaction & communication among family membersFamily members directed to modify patterns of their relationships

41 A. Highly creative, imaginative play B. Early development of language The nurse is providing community education about autism to a group of parents. The nurse concludes that teaching has been effective if the parents describe which of the following as common behavioral signs of autism?A. Highly creative, imaginative playB. Early development of languageC. Overly affectionate behavior toward parentsD. Indifference to being held or huggedD. Indifference to being held or hugged

42 The parent of a child with attention-deficit/hyperactivity disorder (ADHD) tells the nurse that the child doesn’t follow instructions well. Which strategy should the nurse recommend to the parent?A. “Teach your child to be less aggressive and more assertive.”B. “Consider developing a predictable daily routine.”C. “It could be helpful to assign time out if instructions aren’t followed.”D. “Try having your child repeat what was said before starting the task.”D. “Try having your child repeat what was said before starting the task.”

43 A. Amitriptyline (Elavil) B. Paroxetine (Paxil) A 3-year-old client has been diagnosed with attention-deficit/hyperactivity disorder (ADHD). The child’s parents report that a friend told them that the child will likely receive “lots of drugs.” The nurse should reply that the child will most likely be given a drug such as:A. Amitriptyline (Elavil)B. Paroxetine (Paxil)C. Amphetamine and dextroamphetamine (Adderal)D. Haloperidol (Haldol)C. Amphetamine and dextroamphetamine (Adderal)

44 A 13-year-old child is brought to the clinic with a history of a conduct disorder. The nursing history reveals several facts about the family. Which one is most likely to have contributed to the child’s conduct problems? The parents:A. Have very high expectations of the childB. Employ harsh discipline and inconsistent limit-settingC. Are excessively involved in the everyday life ofthe childD. Have no other childrenB. Employ harsh discipline and inconsistent limit-setting

45 Which primary interventions should the nurse plan for when a child has a conduct disorder and is impulsive and aggressive?A. Limit setting and consistencyB. Open communications and a flexible approachC. Open expression of feelingsD. Assertiveness trainingA. Limit setting and consistency

46 Life Span Mental Health IssuesEffect of mental illness on child achieving developmental tasks:May have increased difficulty of achievementMay be stuck in stage at onset of illnessMay never achieve developmental taskCan benefit from nursing interventions

48 Life Span Mental Health IssuesInterventions for increasing resilience in children at risk for disruptive behaviors:Provide a supportive relationship with communitymemberProvide a positive environmentat homeat schoolin community

49 Interventions: Play TherapyCommonly used with childrenPurposeful use of toys and other equipmentHelps to communicate perceptions of the world and to help master the environment self-esteemEnhances problem solvingGains perspective on traumatic event

50 Interventions: PharmacotherapyProzac – the only antidepressant approved for children by FDA. Paxil, Zoloft, Celexa and Effexor considered unsafe and ineffective for most children and dangerous with suicidal tendenciesRisk sudden of death on tricyclic antidepressants (TCAs). Request baseline EKG, repeated when TCA ; blood levels useful in confirming compliance.Lab tests for anemia and thyroid function neededMeds metabolized more efficiently so milligram/kilogram base is used rather than a certain doseInitial doses may be low, but can ultimately be as high as for adults

52 A. Act out feelings in a constructive manner The nurse employs play therapy with a small group of 6-year-old clients. The primary expected outcome is for the clients to do which of the following?A. Act out feelings in a constructive mannerB. Learn to talk openly about themselvesC. Learn how to give and receive feedbackD. Learn how to playA. Act out feelings in a constructive manner

54 Depression & Suicide Adolescent depression symptomsMasked via behavioral problems such as poor school performance and acting out at schoolProtects adolescent from appearing vulnerable and dependentSuicide is 3rd leading cause of death in year olds

55 The nurse is conducting a community education session about preventing deaths in adolescents. Place in order from most frequent to least frequent the causes of preventable adolescent deaths that the nurse needs to include in the presentation.a. Accidentsb. AIDSc. Homicided. Suicide1, 3, 4, 2

56 A. Similar in presentation to depression in adult clients When assessing an adolescent client for depression, it is most important for the nurse to recognize that depression in adolescents is often:A. Similar in presentation to depression inadult clientsB. Masked by aggressive behaviorC. Situational and not as serious asdepression in adultsD. An indication of family dysfunctionB. Masked by aggressive behavior

59 The nurse is teaching a group of young adolescents about eating disorders. The nurse would consider the sessions effective if the participants state that anorexia nervosa is best defined as an eating disorder that occurs:1. Only in young girls who are depressed2. Mainly in young girls who perceive themselves to be grossly overweight3. Primarily in young girls who live in chaotic families4. In young boys and girls alike2. Mainly in young girls who perceive themselves to be grossly overweight

60 The school nurse is conducting an assessment to determine if a client has anorexia nervosa. Which statement(s) by the client most suggest that the client may indeed have anorexia nervosa? Select all that apply.A. “I don’t have periods anymore. I’m glad.”B. “People say I’m skinny, but I’m fat and repulsive.”C. “The idea of eating makes me nauseated.”D. “I know that I have a problem with eating.”A, B, C

61 In order to be admitted to an inpatient treatment program, clients with anorexia nervosa must meet the admission criterion of having experienced at least a 30% weight loss over the immediate past 6 months. The client currently weighs 84 pounds. The nurse calculates that 6 months ago, this client weighed at least _____pounds.120

65 Nursing InterventionsInterventions with the adolescentTherapeutic allianceIdentify feelings and relationship to behaviorReflect on negativism and critical attitudesIdentify tendency to view from extremesEncourage catharsisSkillful milieu management of peer group

66 The nurse is evaluating the progress of an adolescent bulimic client who is being treated as an outpatient. Which behavior would indicate that the client is making positive progress? The client:A. Asks the nurse many details about the nutritional content of foodsB. Shows the nurse a completed food and emotion diaryC. Reports enjoying spending time alone after mealsD. Describes eating at times other than when the family members are eatingB Shows the nurse a completed food and emotion diary

67 A. Rigidly controlling what he or she eats B. Binging and purging The nurse is conducting an in-service education session about the relationship between anxiety and bulimia nervosa. The nurse best describes the relationship by saying, “When a client has bulimia nervosa, an increase in the anxiety level will generally result in:A. Rigidly controlling what he or she eatsB. Binging and purgingC. OvereatingD. Consuming alcoholB, Binging and purging

69 Life Span Mental Health IssuesOlder Adult: InterventionsOlder adults are more prone to the side effects and toxic effects of many medications (at risk populations also include children, pregnant and lactating women).Medications may initially be given at half the normal adult doses and any increases in dosages are made slowly.

72 Life Span Mental Health IssuesOlder Adult: DementiaDevelops gradually; may not be noticed for yearsFirst stage: Confusion, such as about directions (navigational) and decisionsSecond stage: Difficulty recognizing family and friendsThird stage: May refuse to do any Activities of Daily Living (ADLs)Symptoms do not fluctuate in 24-hour periodMay be related to specific medical conditions, such as Parkinson’s disease or HIVIrreversible, progressive cognitive decline including loss of awareness, judgment, ability to reason…severe enough to interfere with daily functioning and communication with others

74 Life Span Mental Health IssuesOlder Adult: DementiaLosses:Ability to do purposeful movement (Apraxia)Inability to acquire and process new informationRecent memory – lost firstRemote memory – more marked as disease progressesLanguage:Anomia – inability to find the right wordAgnosia – inability to identify an objectAphasia – impairment in the significance or meaning of language (inability to understand what is heard, follow instructions, communicate needs)

78 Life Span Mental Health IssuesOlder Adult:Common Interventions for Dementia and DeliriumCheck on frequentlyUse alarm devices to warn of wanderingRemove harmful items from environmentUse respectful mannerPlace calendar and clock in roomReorient each time staff enter roomOthers? What others can you think of?

79 Life Span Mental Health IssuesOlder Adult:Common Outcomes for Dementia & DeliriumRemain free of fallsPerform oral and hair care by given period of timeRemain in bed, on unit or in facility, whichever isappropriate to clientRecall a specific relative by nameAlzheimer’s disease:Locate his or her room at least once a day within thefollowing weekIncrease sleep period at night to ____ hours

81 The client with Alzheimer’s says to the nurse, “I have a date tonight for the Valentine’s dance.” What is the most appropriate response by the nurse?A. “You’re confused again. There isn’t a dance tonight and this isn’t Valentine’s Day.”B. “I didn’t think your spouse was still living. Who is your date with?”C. “I think you need some more medication. I’ll be right back with your shot.”D. “Today is January 11th. Tell me about some of the other dances you’ve been to.”D. “Today is January 11th. Tell me about some of the other dances you’ve been to.”

82 The nurse is teaching a family caregiver how to help a client with early dementia complete activities of daily living (ADLs). Which information should be included in the teaching?A. Perform the ADLs for the client.B. Have the client plan a schedule for ADLs.C. Give the client ample time to perform the ADLs as independently as possible.D. Tell the client that the ADLs must be finished by 9:00 a.m.C. Give the client ample time to perform the ADLs as independently as possible.